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Medicare Fraud
Here are examples of Medicare fraud:
- Billing for services or supplies that were not provided
- Altering claim forms to obtain a higher payment amount
- Billing twice for the same service or item
- Billing separately for services that should be included in a single
service fee
- Misrepresenting the diagnosis to justify payment
- Continuing to bill for services or items no longer medically
necessary
- Billing for rental equipment after date of return
- Billing “non-covered” services or items as
“covered” services
- Ordering unnecessary lab tests
- Refusing to bill Medicare for covered services or items
- Using another person's Medicare card to obtain medical care
- Soliciting, offering, or receiving a kickback, bribe, or rebate (for
example, paying for referrals of patients)
- Completing a Certificate of Medical Necessity (CMN) for a patient
not professionally known by the provider
- Completing a CMN when not authorized (for example, a supplier
completing a CMN for the physician)
- Signing authorizations for medical equipment or procedures that are
not medically necessary
- Waiving co-insurance or deductible
- Billing for home health care services for patients who do not meet
the requirement of “homebound” status
- Using unethical or unfair marketing strategies, such as offering
beneficiaries free groceries or transportation to switch providers
- Billing social activities as psychotherapy
- Billing group services as individual services for each patient in
the group
- Repeatedly violating the participation agreement, assignment
agreement, or limiting charge
- Outpatient hospital services provided within 72 hours of surgery or
other inpatient procedure (known as “the 72-hour rule”)
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Disclaimer